International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41616076 Sex-specific differences in chronic rhinosinusitis with nasal polyps: toward more personalized management 1 1 EN S. Toppila-Salmi Kuopio, Finland 3426 10.4193/Rhin26.901 Chronic rhinosinusitis with nasal polyps (CRSwNP) is increasingly recognized as a biologically heterogeneous disorder, in which patient-specific factors strongly influence outcomes. Among these, sex-related differences have been observed clinically, yet their underlying pathological basis and impact on postoperative recurrence remain incompletely understood.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41191375 Clinical utility of Th2-related markers for local allergic rhinitis: a meta-analysis and indirect comparison of diagnostic test accuracy 2 13 EN M.P. Hoang Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand;Department of Otolaryngology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam K. Seresirikachorn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand W. Chitsuthipakorn Center of Excellence in Otolaryngology-Head and Neck Surgery, Rajavithi Hospital, Bangkok, Thailand;Department of Otolaryngology, College of Medicine, Rangsit University, Bangkok, Thailand K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand 3380 10.4193/Rhin25.237 BACKGROUND: The role of Th2-related biomarkers as a diagnostic tool for local allergic rhinitis (LAR) remains controversial. This study seeks to assess the clinical utility of these markers and rank their diagnostic accuracy for LAR. METHODS: Systematic searches were conducted across five electronic databases. Pooled outcomes, including sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR), were calculated. Relative diagnostic outcomes with a 95% confidence interval between index tests were computed using the indirect comparison of modalities. RESULTS: Twenty-one studies met the inclusion criteria, assessing the diagnostic accuracy of three index tests compared to nasal provocation test for LAR. Among the three biomarkers, sensitivities ranged from 48.1% to 69.1%, with nasal eosinophilia (nEos) showing the highest sensitivity but lowest specificity (56.2%). Nasal-specific IgE (nsIgE) demonstrated perfect specificity (100%) but limited sensitivity (48.1%), the highest DOR (significant), and the highest LR+ (not significant). Basophil activation test (BAT) had the lowest LR- with statistical significance. Indirect comparisons showed BAT and nsIgE had significantly higher sensitivities than nEos. CONCLUSIONS: Nasal-specific IgE and the basophil activation test can help diagnose local allergic rhinitis, but their sensitivities are low. Negative results should be confirmed with a nasal provocation test. Heterogeneity in reported sensitivities further underscores the limitations of current diagnostic methods.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41247333 Effect of corticosteroids on tissue eosinophilia in chronic rhinosinusitis: a systematic review and meta-analysis 14 25 EN N.R. Schlapfer Department of Otorhinolaryngology / Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland;Department of Surgery, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York, United States M.B. Soyka Department of Otorhinolaryngology / Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland R. Liechti Department of Surgery, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York, United States C.M. Meerwein Department of Otorhinolaryngology / Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland 3385 10.4193/Rhin25.097 INTRODUCTION: This systematic review and meta-analysis evaluated the effect of oral corticosteroid (CS) treatment on tissue eosinophil count (EC) in chronic rhinosinusitis (CRS) patients. METHODOLOGY: A comprehensive database search identified 16 studies with 1,003 patients for the systematic review. Nine studies with 493 patients reporting mean tissue EC per high-power field (HPF) with 400x magnification were included in the meta- analysis. Within-subject (pre- vs. post CS treatment) and controlled comparisons (oral CS vs. no CS or topical CS) were analyzed. RESULTS: Results showed a significant reduction in tissue EC following oral CS treatment in both within-subject analyses and controlled trials. A similar effect was found when comparing oral vs. topical CS treatment. Meta-regression showed a significant negative association between cumulative CS dose and post-treatment EC/HPF. CONCLUSION: These findings provide strong evidence that oral CS significantly reduces tissue eosinophilia in CRS, including comparisons with topical CS. The effect was consistent across study designs and should be considered when assessing endotypes in CRS with nasal polyps.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41143461 Sex differences in CRSwNP: focus on histopathological endotypes and recurrence 26 37 EN W. Chen Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China;Tangxia Laboratory, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China H. Wang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China;Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China D. Wang Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China W. Li Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China;Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Li Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China J. Chen Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Q. Yang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China;Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Zhang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China;Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China 3377 10.4193/Rhin25.348 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits sex-specific differences in prevalence and clinical presentation. However, the underlying histopathological characteristics and recurrence remain underexplored. METHODOLOGY: A retrospective cohort of 410 CRSwNP patients (287 males, 123 females) undergoing endoscopic sinus surgery between January 2021 and June 2024 was analyzed. Histological evaluation was employed by H&E staining and features of inflammatory profile were identified by immunohistochemistry. Multivariate logistic regression and receiver operating characteristic analyses were performed to assess predictors of recurrence. Results: Males exhibited higher body mass index (BMI) and greater allergic rhinitis prevalence, while females had more asthma comorbidity and higher SNOT-22 scores. While no significant sex differences were observed in histopathological endotypes, elevated BMI was more likely to exacerbate inflammation in males than females. Additionally, males showed a higher recurrence rate, with male sex being identified as an independent risk factor. However, females who experienced recurrence exhibited more severe eosinophilic and T2 inflammation compared to their male counterparts. Therefore, higher threshold values for tissue eosinophil counts and Charcot-Leyden crystals were required to predict recurrence in female patients. Conclusions: These findings underscore the necessity for sex tailored therapeutic strategies, particularly emphasizing weight control in male patients and intensified anti-T2 inflammation management in female patients with recurrent CRSwNP. Further research is needed to investigate the underlying causes and to offer evidence-based treatment guidelines.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41283927 Development and psychometric validation of the Chronic Rhinosinusitis Control Test 38 50 EN R.A. Cotter Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA C.W. Lee Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA K. Wilson Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA S.F. Althoff University of Nevada, Reno School of Medicine, Reno, NV, USA S. Alsaleh Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia;Security Forces Hospitals Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia W.T. Anselmo-Lima Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil M. Bernal-Sprekelsen Department of ORL, Hospital Clinic, University of Barcelona, Barcelona Spain R.K. Chandra Department of Otolaryngology â€" Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA J. Constantinidis 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece W.J. Fokkens Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands A.A. Halderman Department of Otolaryngology Head and Neck Surgery, Westchester Medical Center Health Network, Valhalla, NY, USA T. Herzog Department of Asian, East European and German Studies, University of Cincinnati, Cincinnati, OH, USA C. Hopkins Department of Otolaryngology and Head Neck Surgery, Guys and St Thomas’ Hospital, London, UK E.C. Kuan Department of Otolaryngology â€" Head and Neck Surgery, University of California, Irvine, Orange, CA, USA B.N. Landis Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland V.J. Lund Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK J.C. Meier University of Nevada, Reno School of Medicine, Reno, NV, USA;Nevada ENT and Hearing Associates, Reno, NV, USA H.K. Pae School of Education, University of Cincinnati, Cincinnati, OH, USA S.D. Pletcher Department of Otolaryngology â€" Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA S. Reitsma Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands J. Rimmer Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia;Department of Surgery, Monash University, Melbourne, Australia;Department of Otolaryngology Head and Neck Surgery, St Vincent’s Hospital Melbourne, Melbourne, Australia Y.S. Gonzalez School of Education, University of Cincinnati, Cincinnati, OH, USA M.B. Soyka Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland J. Sun Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus, OH, USA S. Toppila-Salmi Department of Otorhinolaryngology, University of Eastern Finland, Joensuu and Kuopio, Finland;Wellbeing services county of Pohjois-Savo, Kuopio, Finland;Department of Allergology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland E.W. Wang Department of Otolaryngology â€" Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA M.B. Wang Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA B.A. Woodworth Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA S.T. Gray Department of Otolaryngology â€" Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA P.H. Hwang Department of Otolaryngology â€" Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA S.K. Wise Department of Otolaryngology, Emory University, Atlanta, GA, USA K.M. Phillips Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA A.R. Sedaghat Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 3388 10.4193/Rhin25.377 BACKGROUND: Disease control assessment for chronic rhinosinusitis (CRS) remains a challenge. In this study, we develop and psychometrically validate a new patient-reported outcome measure, the Chronic Rhinosinusitis Control Test (CRCT), for assessing CRS control. METHODOLOGY: The CRCT, which includes 8 items and has a score that ranges from 0-31, incorporates the perspectives of key stakeholders (patients and healthcare providers) and was developed incorporating methodologic guidance from the COSMIN initiative and United States Food and Drug Administration. Psychometric validation was performed in line with recommendations from the COSMIN initiative to establish validity, reliability and responsiveness in a sample of 545 CRS patients and with the participation of 23 expert rhinologists. RESULTS: The CRCT has excellent face validity, content validity, concurrent validity, internal consistency, test-retest reliability, and responsiveness. Factor analysis reveals that the CRCT has 2 subdomains: sinonasal and impairment subdomains in addition to a final item related to CRS-related oral corticosteroid usage in the past 3 months. Using a distribution-based and multiple anchorbased methods, the CRCT has a minimal clinically important difference (MCID) of 4 points. After 23 expert rhinologists independently classified all possible combinations of scoring on the CRCT, scores of ≤7 indicate controlled CRS, 8 to 15 (inclusive) partly controlled CRS and ≥16 uncontrolled CRS. CONCLUSION: The CRCT is a psychometrically validated measure of CRS control. CRS may be classified as controlled based on CRCT score ≤7, partly controlled with CRCT score of 8 to 15 (inclusive) and uncontrolled with CRCT score ≥16. The MCIDs for improvement and worsening are both 4.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41051759 Improving sleep in severe CRSwNP: an RCT on the effect of mepolizumab and FESS on OSA, sleep disturbances and quality of life 51 57 EN A.S. Homoe Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark E.K. Kiaer Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark K. Aanaes Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark J. Tidemandsen Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark P. Jennum Department of Clinical Neurophysiology, Copenhagen University Hospital (Rigshospitalet), Glostrup, Denmark V. Backer Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark 3362 10.4193/Rhin25.228 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to poor sleep quality and fatigue. Many patients with CRSwNP are also at risk for obstructive sleep apnea (OSA). This study examined how mepolizumab and/or endoscopic sinus surgery (FESS) affect sleep quality and OSA in patients with severe uncontrolled CRSwNP. METHODS: In a randomised trial with 58 patients, participants received mepolizumab alone or combined with FESS. Sleep quality was measured using FOSQ-10 and ESS, and OSA severity via AHI from home sleep apnea tests. RESULTS: At baseline, 70% of participants had OSA (AHI ≥5), with 34.6% having moderate-to-severe OSA. After six months, there were significant improvements in sleep quality (SNOT-22, FOSQ-10, ESS) in both groups but no significant change in objective OSA measures (AHI, ODI). Patients with OSA showed a reduction in severity, however non-significant. There were no severe adverse events (SAE) during the follow-up. CONCLUSIONS: Mepolizumab, with or without FESS, improved subjective sleep quality and reduced fatigue but did not significantly affect OSA severity. This suggests that while treatment eases sleep-related symptoms, it may not resolve underlying OSA, particularly in more severe cases.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41235453 Orthonasal and retronasal olfactory function in olfactory cleft obstructions 58 66 EN J.H. Juratli Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany;Stanford University School of Medicine, Stanford, California, USA C. Huart Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium V. Hox Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium P. Rombaux Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany 3383 10.4193/Rhin24.049 BACKGROUND: A healthy olfactory cleft is critical to normal olfactory function. The aim of this study was to explore the differential orthonasal and retronasal olfactory functions in patients with olfactory cleft (OC) obstructions including a combination of OC syndrome, chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), and respiratory adenomatoid epithelial hamartoma (REAH). METHODS: Patients (n = 93) presenting to an ENT clinic with OC obstruction underwent nasal endoscopy, chemosensory event-related potential (ERP) recordings, and radiologic assessment, and were subsequently diagnosed with OC syndrome, CRSsNP with OC syndrome, CRSwNP in the OC, REAH, and CRSwNP with REAH. Orthonasal and retronasal function were assessed using the complete Sniffin’ Sticks test and a set of 30 powders, respectively. RESULTS: Orthonasal function was lower in patients with REAH and CRSwNP+REAH compared to CRSwNP in OC patients. Retronasal function was similarly diminished in REAH compared to CRSwNP in OC. Patients with OC syndrome alone had higher orthonasal scores than those with CRSsNP plus OC syndrome and CRSwNP in OC but not statistically different retronasal function. There was no significant difference in orthonasal or retronasal scores in REAH patients based on concurrent CRSwNP. CONCLUSIONS: REAH corresponded with greater orthonasal and retronasal olfactory loss compared to other olfactory cleft obstructions, indicating a greater effect on the olfactory mucosa beyond disrupting airflow. The difference between CRS and OC syndrome is more pronounced orthonasally than retronasally.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41307355 Association of olfactory impairment and short telomere length: the smell of biological aging? 67 74 EN V. Van Regemorter Department of Anesthesiology, Cliniques universitaires Saint-Luc, Brussels, Belgium;Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium K. Bouchoucha de Duve Institute, Université catholique de Louvain, Brussels, Belgium P. Rombaux Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium M-A. Van Dievoet Department of Clinical Biology, Cliniques universitaires Saint-Luc, Brussels, Belgium T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Dresden, Germany A. Decottignies de Duve Institute, Université catholique de Louvain, Brussels, Belgium C. Huart Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium;Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium 3390 10.4193/Rhin24.500 BACKGROUND: Olfactory dysfunction is a common issue among the older population and has been associated with both frailty and increased mortality risk. Telomere length (TL), a marker of biological aging, may provide insights into these associations. This study investigates the relationship between TL and olfactory function in older adults. METHODOLOGY: We conducted a prospective observational study involving 138 participants aged 65 and above, recruited from a preoperative anesthesia clinic. Olfactory function was assessed using the Sniffin' Sticks test, and TL was measured in leukocytes using the Flow-FISH technique. Data analysis included comparisons between short TL ((lower than the 10th percentile) and normal TL (above the 10th percentile) groups, considering factors like age, sex, and frailty. RESULTS: Short TL was found in 27.5% of participants. Those with short TL had significantly lower TDI (threshold, discrimination, identification) scores. Specifically, 46.2% of participants with a TDI score lower or equal than 10th percentile had short TL compared to 23.2% with higher TDI scores. Adjusting for frailty attenuated this relationship, indicating a shared biological component between olfactory function and TL. CONCLUSIONS: Our study reveals a significant association between lower olfactory function and shorter TL in older adults, suggesting that olfactory impairment may reflect underlying biological aging. Further research is needed to elucidate the complex interactions between olfactory function, TL, and frailty.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 Effects of Elexacaftor Tezacaftor Ivacaftor on sinonasal imaging in children with cystic fibrosis 75 82 EN G. Petit Hospital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France A. Coudert Hospital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France R. Hermann Hospital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France E. Truy Hospital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France M. Bonjour Hospital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France P. Reix Hospital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France S. Ayari Hospital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France 3353 10.4193/Rhin24.533 BACKGROUND: New CFTR Modulator triple therapy Elexacaftor-Tezacaftor-Ivacaftor (ETI) has proven efficacy in pulmonary outcomes. However, its qualitative impact via sinonasal imaging in children has not been specifically studied. The aim of our study is to assess the impact of ETI triple therapy through sinus imaging in children with Cystic Fibrosis (CF) aged 6â€"12 years. METHODS: This prospective, single-center study, covered children with CF aged 6-12 years, all undergoing annual low-dose CT scans of the sinuses and lungs. The main objective of our study is the evaluation of the evolution of the modified Lund-Mac Kay (mLMK) score. Evaluations occurred at baseline and after one year of ETI therapy. Secondary objectives included the identification of potential associations between mLMK score and Sinus and Nasal Quality of Life Survey Score (SN-5) score, as well as examination of mLMK score changes in individual sinuses. RESULTS: 26 patients were enrolled in our study. The median mLMK score significantly improved after one year of ETI therapy. Significant correlation was observed between mLMK and SN-5 scores. CONCLUSION: This study highlights ETI's efficacy in improving sinonasal involvement in children aged 6 to 12 with CF. This is in line with the observations of clinical improvement, and presents an alternative to sinus surgery, thus potentially leading to a reduction in surgical interventions.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 40988571 A positive correlation between autonomic nervous system function and endoscopic disease severity in chronic rhinosinusitis: a quantitative assessment 83 89 EN W-C. Chen Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan;School of Medicine, College of Medicine, National SunYat-sen University, Kaohsiung, Taiwan S-D. Luo Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan;School of Medicine, College of Medicine, National SunYat-sen University, Kaohsiung, Taiwan;School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan;Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan C-N. Wu Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan;School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan C-H. Cha Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan W-S. Chen Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan S-F. Chen Department of Neurology, Cognition and Aging Centre, Kaohsiung Chang Gung Memorial Hospital and Chang Gung, Chang Gung University College of Medicine, Kaohsiung, Taiwan 3357 10.4193/Rhin25.203 INTRODUCTION: The autonomic nervous system (ANS) regulates respiratory mucosal inflammation and is linked to various airway diseases. However, the relationship between ANS dysfunction and chronic rhinosinusitis (CRS) has not been fully investigated. This study aimed to explore the association between ANS and CRS using a battery of quantitative autonomic function tests. METHODS: Patients with CRS undergoing surgery were prospectively enrolled. Subjective evaluation of disease severity was assessed using the sino-nasal outcome test-22 questionnaires for CRS and the 31-item composite autonomic symptom score questionnaires for ANS dysfunction, while computed tomography and endoscopic scores represented objective severity. A battery of autonomic function tests was conducted, and the results were used to generate the modified composite autonomic scoring scale (mCASS) to provide a quantitative evaluation of ANS function. RESULTS: A total of 49 patients were enrolled. The most common dysautonomic symptoms were dry mouth (73.5%), dizziness (71.4%), and dry eyes (55.1%). Twenty-six patients (53.1%) had a positive mCASS score, indicating abnormal autonomic function. Within the subdomains, most abnormalities were observed in the sudomotor score (28.6%). The mCASS score showed a positive correlation with the endoscopic score, with marginal significance. Notably, the sudomotor subdomain score was significantly correlated with the endoscopic score. CONCLUSION: A significant correlation was found between objective autonomic nervous system function and severity of chronic rhinosinusitis, particularly in the sudomotor subdomain, suggesting a link between peripheral cholinergic activity and sinonasal inflammation. Further research is needed to clarify the underlying mechanisms.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41081455 Three-dimensional anatomy of the junction between the posterior ethmoidal region and the sphenoid sinus 90 100 EN M. Eordogh Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany A.A. Menabbawy Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany L. Barany Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen, Germany M. Kirsch Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany R. Reisch Endomin - Centre for Endoscopic and Minimally Invasive Neurosurgery, Zurich, Switzerland G. Baksa Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary H.W.S. Schroeder Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany W. Hosemann Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Greifswald, Greifswald, Germany H.R. Briner Center for Otorhinolaryngology, Head and Neck Surgery, Zurich, Switzerland 3366 10.4193/Rhin24.565 BACKGROUND: The anatomy of the sphenoethmoidal recess is of clinical importance, however, the literature focuses on the superior turbinate and the sphenoid ostium. We analyzed the entire junction of the posterior ethmoidal region and the sphenoid sinus (SEJ) to define possible regularities. METHODS: We analyzed the junction between the posterior ethmoidal region and the sphenoid sinus on CT scans of 100 paranasal sinuses from 50 individuals using the 3D Slicer software. RESULTS: The SEJ had two components: medially the sphenoethmoidal recess, laterally the wall between these aeriated regions, the latter built by the basal lamella of the superior turbinate (4BL) in 92.0%. The 4BL was a constant structure (100.0%), its most frequent phenotype was a frontally oriented pentangular wall without dehiscences (44.0%). There were no bony walls between the 3BL and the anterior wall of the sphenoid sinus in 49.0% and there was one wall in 42.0%. The 4BL had three complicating factors: firstly, it shifted to anterior, if the supreme turbinate was present (43.0%). Secondly, the pneumatization of the 4BL and the superior turbinate (25.0%) was related to an incomplete-dehiscent anterior 4BL wall. Thirdly, sphenoethmoidal cells (36.0%) led to a bony contact of the optic canal and the 4BL (33.0%). CONCLUSIONS: The 4BL is an important landmark for endoscopic sinus and skull base surgery with highly constant morphology and a typical phenotype. Surgeons should be aware that after dissection of the 3BL the next wall is likely the 4BL which mostly merges to the ASW. This study can help surgeons to detect anatomical variations and improve their intraoperative orientation.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41059564 Neuroinflammation and neural activity in the olfactory bulb drives olfactory dysfunction in a rat model of eosinophilic chronic rhinosinusitis 101 112 EN Z. Zhang Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China Y. Du Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China S. Xiong Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China W. Cao Department of Otolaryngology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China H. Jiang Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China J. Wang Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China M. Li Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China Y. Hu Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China F. Ma Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China Y. Zhang Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, China 3365 10.4193/Rhin25.164 BACKGROUND: Chronic rhinosinusitis (CRS) is a common cause of olfactory dysfunction (OD), and eosinophilic CRS is one of the subtypes characterized by eosinophilic infiltration. Animal models of olfactory dysfunction in eosinophilic CRS are necessary for exploring potential therapeutic strategies. Glucocorticoids are therapeutic for eosinophilic CRS-OD and the mechanism of action requires further exploration. METHODOLOGY: The eosinophilic CRS-OD rat model was induced by intranasal administration of ovalbumin (OVA) and Aspergillus oryzae protease (AP) for 8 weeks, followed by intraperitoneal injection of dexamethasone. Olfactory function was assessed behaviorally, neuronal activity electrophysiologically, and neurotransmitter/inflammatory factor levels via high-performance liquid chromatography (HPLC). Histological analyses of nasal tissue and the olfactory bulb were performed. RESULTS: All OVA/AP-induced eosinophilic CRS-OD rats developed chronic nasal inflammation and olfactory dysfunction. Reduced olfactory bulb (OB) volume was accompanied by thinning of the olfactory neuron layer (ONL) and the glomerular layer (GL). The OB exhibited increased microglia and elevated inflammatory cytokine expression. Further analysis revealed decreased glutamate (Glu), increased γ-aminobutyric acid (GABA), and a significant reduction in the spontaneous firing rate (SFR) of mitral/tufted cells (M/Ts) within the OB. Dexamethasone treatment significantly ameliorated olfactory impairment in this model, decreasing OB microglia numbers and inflammatory cytokine levels, and significantly increasing M/T SFR. CONCLUSIONS: Microglia-mediated neuroinflammation contributes to abnormal neural activity in the olfactory bulb, which may be one mechanism for the development of eosinophilic CRS-OD. The neuroprotective effect of dexamethasone, mediated through microglial inhibition, highlights microglia as an important therapeutic target for eosinophilic CRS-OD.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41171089 Local IgE is a superior biomarker than serum IgE for nasal type 2 inflammation in house dust mites sensitized allergic rhinitis 113 121 EN Z. Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China X. Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China J. Li Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China Y. Song Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China L. Xi Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China C. Wang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China L. Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China Y. Zhang Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China;Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China;Laboratory for Clinical Medicine, Capital Medical University, Beijing, China 3379 10.4193/Rhin25.381 BACKGROUND: Allergic rhinitis (AR), an immunoglobulin E (IgE)-mediated inflammatory disease, is frequently associated with house dust mites (HDMs), particularly Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f). While serum allergen-specific IgE (sIgE) is widely used, the diagnostic value of local sIgE and its interplay with systemic IgE and nasal cytokines remains unclear. This study evaluated local sIgE performance, nasal cytokine profiles, and nonlinear local-serum sIgE dynamics for AR patients. METHODOLOGY: This prospective study enrolled 60 HDM-sensitized AR patients and 143 healthy controls from February 2023 to September 2024. Serum and local Der p/Der f sIgE and total IgE were quantified; and nasal cytokines were analyzed by Luminex. Logistic regression, ROC analysis, and Spearman correlation assessed diagnostic performance and associations.Restricted cubic spline (RCS) modeling explored nonlinear local-serum sIgE relationships. RESULTS: AR patients exhibited elevated local Der p and Der f sIgE logistic regression confirmed their associations with AR, supported by strong diagnostic accuracy. Local sIgE demonstrated stronger correlations with type 2 cytokines (IL-4, IL-5, CCL5, CCL11) than serum sIgE. RCS analysis identified inflection points for Der p and Der f, revealing threshold-dependent nonlinear dynamics between local and serum sIgE. CONCLUSIONS: Local sIgE demonstrates high diagnostic accuracy for HDM-sensitized AR and better reflects local Th2-driven inflammation. The nonlinear local-serum sIgE relationship advocates dual-compartment profiling, advancing precision diagnostics in AR.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41081462 EBV genome-guided transcriptomic re-annotation reveals molecular subtypes of nasopharyngeal carcinoma informing prognosis and treatment 122 136 EN Q. Ding Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China Y. Pan Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China W. Lin Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China H. Yang Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China X. Chen Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China H. Li Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China Y. Weng Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China S. Qiu Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, China;Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China 3367 10.4193/Rhin25.274 BACKGROUND: Non-keratinizing nasopharyngeal carcinoma (NPC) is closely related to Epstein-Barr virus (EBV) infection. Patients with NPC often exhibit diverse treatment responses due to tumor heterogeneity. Thus, identifying molecular subgroups based on EBV involvement holds promise for refining personalized treatment strategies and improving treatment outcomes in NPC patients. METHODS: 193 treatment-naive NPC specimens with comprehensive clinical and pathological data were procured from Fujian Cancer Hospital. RNA sequencing was employed to acquire the gene expression profiles, followed by the re-annotation of 100 EBV-associated genes leveraging the EBV sequence. Molecular subtypes were conducted via consensus clustering, with an external NPC cohort serving as a validation dataset. Scissor method was applied to identify survival-associated cell subpopulations from single-cell data, following comprehensive bioinformatic analyses. RESULTS: Three molecular subtypes of NPC-CoriLyt, Cneg, and CEB1-were identified, each with specific clinical profiles. The CEB1 subtype is distinguished by its heightened metabolic activity and immunosuppressive environment. A hub-gene-based risk model for these subtypes strongly predicted disease-free survival, with replicated results in the validated cohort. The model's predictive accuracy was high, with areas under the curve for 1, 3, and 5-year survival rates at 0.79, 0.86, and 0.88, respectively. M2-type macrophages exhibit a high-risk score profile and play a critical role in EBV infection, with prominent activation of the TNF-II and TGF-B signaling pathways. CONCLUSIONS: This study introduced a new EBV-related transcriptomics-based classification system for NPC that showed great promise in predicting patient survival outcomes.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41247343 Olfactory dysfunction in adult cystic fibrosis patients 137 139 EN A. Minzoni Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy P. Orlando Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy L. Mazzetti Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy A. Ricchiuti Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy S. Bresci Cystic Fibrosis Unit, Careggi University Hospital, Florence, Italy G. Maggiore Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy 3386 10.4193/Rhin25.243 Olfactory dysfunction is a frequent yet underrecognized manifestation of chronic rhinosinusitis in cystic fibrosis. Despite widespread reports of OD in CF, the impact of CFTR modulator therapy on smell outcomes remains unclear. We conducted a prospective study to evaluate olfactory function changes in CF-related CRS patients, as defined by EPOS2020, following 12 months of elexacaftor/tezacaftor/ivacaftor therapy, exploring clinical and biological correlates. From 120 ETI-treated CF patients at the University Hospital of Careggi, 45 adults diagnosed with CRS completed pre- and post-treatment assessments, including olfactory evaluation via the 16-item Sniffin’ Sticks Identification Test for its feasibility and longitudinal applicability.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41235417 Is routine cocaine testing justified in patients with septal perforation? 140 141 EN R.A. Algazlan Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, United Kingdom T. Soares Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, United Kingdom T. Ross Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, United Kingdom C. Rennie Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, United Kingdom 3382 10.4193/Rhin25.055 Nasal septal perforation occurs when both mucoperichondrial layers surrounding the septal cartilage are compromised. While richly vascularized, this tissue is particularly vulnerable to ischaemic injury caused by intranasal cocaine use. Cocaine inhibits catecholamine reuptake, leading to vasoconstriction, tissue necrosis, and, ultimately, septal damage. Furthermore, the adulterant levamisole, present in up to 80% of seized cocaine in Germany, is a known trigger for vasculitis, compounding this effect.

International Rhinologic Society Rhinology 0300-0729 64 1 2026 February 1 41284038 Higher rate of local recurrence in sinonasal squamous cell carcinoma arising from inverted papilloma compared to de novo tumours 142 144 EN M-H. Dong Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Education and Research, Taipei Veterans General Hospital, Taipei, Taiwan Y-W. Chen Department of Otorhinolaryngology, Chi-Mei Medical Centre Y-W. Huang Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan L-T. Hung Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan C-F. Yeh Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan M-Y. Lan Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan Y-T. Chao Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan 3389 10.4193/Rhin25.283 Squamous cell carcinoma (SCC) is the most common histological subtype of sinonasal malignancies. Due to non-specific symptoms, sinonasal SCC (SNSCC) is often diagnosed late, posing challenges for management. SNSCC can arise de novo (DN-SCC) or from the malignant transformation of inverted papilloma (IP-SCC). Prior studies have reported inconsistent outcomes comparing these two subtypes. This study compares recurrence patterns and survival outcomes of DN-SCC and IP-SCC, identifies predictors of recurrence and survival, and aims to inform clinical decision-making and patient counselling.